Gout is an excruciatingly painful inflammatory disease of the joints. It is caused by an increased blood level of uric acid, which, when crystallized, can produce inflammation in the joints and surrounding tissues. Gout has been linked to major medical conditions such as heart attack, diabetes, and premature death. For years, gout has been thought to affect mostly men. Legends of kings suffering from podagra (a gout attack in the big toe) after eating meat and drinking alcohol led to gout being called "the disease of kings." However, over the last several decades, the frequency of gout has almost doubled, including in women. The November 24, 2010, issue of JAMA includes an article showing that this phenomenon among women might be related to an increased intake of fructose (a fruit sugar) because of increased consumption of fructose-rich beverages.

SYMPTOMS

Typical gout attacks involve

Pain in a red, swollen, warm joint

The big toe and feet most commonly, but also other joints

As gout progresses, these attacks tend to occur more frequently and may lead to chronic gouty arthritis characterized by

Tophi (uric acid deposits in soft tissues and joints)

Joint deformity

Decreased joint mobility

Chronic pain

DIAGNOSIS, PREVENTION, AND TREATMENT

The diagnosis of gout is aided by review of medical history, symptoms, physical examination, and assessment of blood uric acid level and is confirmed by the presence of uric acid crystals in the joint fluid. Steps for prevention of gout attacks include

Avoiding purine-rich food (eg, steaks, organ meats, and seafood)

Limiting alcoholic and fructose-rich beverages

Losing weight

Discuss with your doctor medications you are taking because certain medications such as diuretics (sometimes called "water pills") may also increase your risk of gout. Gout flares tend to resolve within 5 to 7 days even without treatment but often recur. The pain and the length of gout attacks can be significantly reduced by nonsteroidal anti-inflammatory drugs (eg, ibuprofen, indomethacin) or colchicine, and taking these medications within 24 hours of attacks is usually the first line of defense. An ice pack placed on the affected joint can also help relieve pain associated with gout attacks. For further advice on coping with gout attacks and lowering uric acid to prevent future attacks, you should consult your doctor. Seeing your doctor regularly is important so that gout and uric acid levels can be followed and managed appropriately.

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Sources: National Library of Medicine at the National Institutes of Health, Centers for Disease Control and Prevention

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